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Chiropractic, Naturopathic and Acupuncture Leaders Step Up to the Challenge

Action relative to the nation’s opioid challenges is escalating. The sight of the $1.1-billion Opioid Initiative proposed by President Obama in the next federal budget to fight the opioid abuse epidemic has brought activity to the forefront. The particularly good news is that a number of integrative health professional organizations are stepping up to address non-opioid pain management methods. Here is a quick overview.

American Chiropractic Association’s Position Statement and Campaign

At the 2016 National Chiropractic Leadership Conference (NCLC), the House of Delegates of the American Chiropractic Association (ACA) adopted a policy statement noted here “proposing a solution to the dual public health concerns of inadequate pain management and opioid abuse.” The policy statement resolved that “a coordinated, multi-faceted expansion of integrated evidence-based, non-pharmacologic therapies as front-line treatment options for pain is warranted.” They recommended the following action steps:

investigation of non-pharmacologic interventions for pain treatment across a variety of patient populations and care delivery settings,

the promotion of evidence-based non-pharmacologic therapies within best practice models for pain management

policy to improve access to providers of non-pharmacologic therapies

inter-professional education to augment the training of pain management teams, and

public health campaigns to raise awareness of drug-free treatment options for pain syndromes.

The ACA’s incoming president David A. Herd, DC. comments that “chiropractic’s non-drug approach to pain management puts this profession in a unique position to help reduce the prescription drug abuse, misuse and overdose that is currently plaguing the nation.”

Comment: Credit the chiropractic association for a statement that rolls in all non-opioid pain management methods and non-pharmacologic approaches. This is excellent leadership – showing up with the generosity of spirit to make the case for the whole family of approaches and providers that are too often over-looked or down-played.

American Association of Naturopathic Physicians Offers Itself as an Educator to the AMA

The president of the American Medical Association, Steven Stack, MD, issued a call to action on the roles of physicians in “turning the tide of the opioid epidemic.” In a five-point program, Stack included specific notice that there are “significant barriers to providing non-opioid and non-pharmacologic treatment alternatives.” He then added that “we should ask ourselves two simple questions: When was the last time we looked at the research on opioid alternatives?”

The American Association of Naturopathic Physicians (AANP) decided that Stack’s posting was a call for help. The AANP sent a media release “applaud[ing] the decision of the American Medical Association (AMA) to help prevent opioid misuse.” The AANP’s president Jaclyn Chasse, ND then shared that it is “pleased to offer naturopathic physicians as an education resource in this area.” To which Ryan Cliche, executive director of the AANP, followed: “There is a tremendous need for education in this area. We encourage medical societies and medical education companies to collaborate with [the] AANP on this effort.”

Comment: Here’s hoping that the AANP is following this excellent suggestion up with direct contact with the AMA in both Washington, D.C. and Chicago. Hopefully their education will be from their perch as physicians with a broad, integrative scope of non-pharmacologic practice – promoting all that may be of use, including massage therapists, mind-body experts, chiropractors, acupuncturists and others. The ACA provides a good example in the positioning.

Acupuncture Foundation and American Society for Acupuncturists Make Case to CDC on Opioids

The Joint Acupuncture Opioid Task Force, the Acupuncture Now Foundation (ANF) and the American Society of Acupuncturists filed a response to the Center for Disease Control and Prevention on its 2016 Guideline for Prescribing Opioids. The organizations specifically sought to “help improve the quality of information currently found in the draft of this guideline, specifically the sections dedicated to ‘Contextual Evidence Review’ of ‘non-pharmacologic alternatives.’” The 10-page document includes a 2-page cover letter, findings of its expert committee, 45 scientific references, and a two-page chart, “The Effectiveness and Harms of Acupuncture.” The Task Force’s finding included the following:

Acupuncture is an effective, safe, and cost-effective treatment for various types of pain. Acupuncture should be recommended for the treatment of pain before opiates are prescribed.

Acupuncture analgesic mechanisms have been extensively researched and include the production and release of endogenous opioids.

Acupuncture is effective for the treatment of chronic pain involving adverse neuroplasticity.

Acupuncture is a useful adjunctive therapy in opiate dependency and rehabilitation.

The Task Force finished its cover letter with this: “Considering the magnitude of the opioid crisis, non-opioid alternative approaches to the management of chronic pain that are shown to be safer, while of equal or superior clinical effectiveness to opioids, should not merely be categorized as a ‘possible option’. The research presented below demonstrates these positions and we urge policy makers to carefully consider this information and contact us with and questions.”

Comment: This is and was great work. The assertiveness is spot on: not a “possible option” but a priority option: Never Only Opioids. Notably the professional organization at the table was the relatively new American Society of Acupuncture. This group would serve itself well to follow-up their document with direct contacts with the right people at the CDC. Covering these three stories together makes me think of the potential value if all 3 parties worked together to meet the education gap identified by the AMA, and to which the AANP’s media release responded. Good work from each.

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John Weeks is a writer, speaker, chronicler and organizer with 32 years of experience in the movement for integrative health and medicine. the long-time founder/editor of The Integrator Blog News & Reports, a primary connective terrain for the diverse stakeholders and professions in the field and was invited in May 2016 to serve as editor-in-chief of the Journal of Alternative and Complementary Medicine. Besides his Integrative Practitioner column, he presently writes for Integrative Medicine: A Clinician’s Journal, the Huffington Post and elsewhere. He increasingly enjoys teaching and mentoring. He has keynoted, led plenary sessions, breakouts and offered guest lectures for dozens of organizations ranging from the Bastyr University to the Association of American Medical Colleges, the UCLA School of Medicine to the Institute for Health and Productivity Management, the AANP and AIHM to the American Hospital Association. He has consulted with insurers, employers, professional organizations, universities and government agencies at all levels. As an organizer, Weeks convened the Integrative Medicine Industry Leadership Summits (2000-2002), directed the National Education Dialogue to Advance Integrated Care (2004-2006), fund-raised the start-up of the Integrated Healthcare Policy Consortium (2002), and co-founded the Academic Collaborative for Integrative Health, which he directed 2007-2015. In 2014, three consortia and others combined to grant him a Lifetime Achievement Living Tribute Award. Four academic institutions have granted Weeks honorary doctorates for his work. Seattle-based, he considers himself a particularly lucky soul to have worked remotely while living with his spouse Jeana Kimball, ND, MPH, and their children in Costa Rica, Nicaragua and Puerto Rico for 6 of the last 15 years.

That’s great to hear, Ryan. We have definitely found that – heeding Tom Harkin’s urge of 20 years ago that “all of you get together on what you want” – has had success, through both the Integrative Health Policy Consortium, where AANP is an active participant, of course, and the Academic Collaborative for Integrative Health (the former ACCAHC). Integrative pain care is a natural for collaboration – and I think that a battle cry of “Never Only Opioids” – which an interprofessional group of us put together here http://www.painsproject.org/policy-brief-never-opioids/ – is a good banner! Glad AANP is interested. BTW, Kevin Wilson, ND, from Oregon, was the ND on that ND-LAc-massage therapist-chiropractor-integrative MD team,

Thanks, John, for sharing this important collection of perspectives. The opioid crisis is deeply rooted into our country and requires multi-disciplinary and comprehensive approaches in order to be meaningfully addressed. The “just say no” approach has proven to be more of a setback than a serious public health policy.

A naturopathic colleague did a epidemiological study a few years ago that showed that emergency room admissions for opioid overdose in Colorado dropped dramatically after they legalized marijuana. I don’t understand why we are not promoting cannabis as the alternative herb for pain management. As a person who has suffered from rheumatoid arthritis for over a decade, I can attest that acupuncture and chiropractic, while certainly useful, often do not provide enough pain relief for many conditions. These modalities are also expensive and need to be continued, often indefinitely. We are missing the boat (once again) by not claiming and promoting this herb as a naturopathic pillar of pain management. You can bet that conventional medicine will eventually claim it as their own.

Hello Victoria. Interesting perspective. What is it, half the states now roughly have legal medical use? My guess is that there are those who ARE promoting this. Not sure what the AANP might be doing as the national naturopathic organization on this front. My own view is that nothing is “the” alternative – and at the same time this could be a naturopathic pillar, or even a non-conventional pillar, where legal.

It is very encouraging to hear about the national efforts from ACA, AANP, and acupuncture groups on this topic. In Colorado, the newly created five-year state-wide Colorado Cancer Plan includes strategies for state and local stakeholders on this issue. Objective 10.2 states: Increase access to non-pharmacologic interventions for cancer pain management, palliative care, and wellness.

HI John, thanks for the great article! While the abuse of opioids is not very well-known and spending has started coming now to move toward non-opioids, I’m wondering if non-opioids could so as well as their opioid counterparts in pain management?

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